Why the Definition of Pain Matters

In July 2020, the International Society for the Study of Pain redefined pain.

It doesn’t sound like a big deal. We all know what pain is, right? Not something that would take a bunch of scientists several years consulting with many different stakeholders.

But it is. Here is what they wrote:

Pain is: “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”

International Society for the Study of Pain

They went on to discuss six important related points:

• Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
• Pain and nociception (the neural processes of encoding and processing noxious stimuli) are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
• Through their life experiences, individuals learn the concept of pain.
• A person’s report of an experience as pain should be respected.
• Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
• Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

Two main points

In this article I want to focus on two specific points I found important about the definition.

Healthy pain is protective.

First, is that the purpose of healthy pain is to keep us safe. Pain’s primary purpose is to warn us of impending or actual tissue damage.

It does so by alerting us because the strong aversive stimulus (OUCH!) grabs our attention, stops us in our tracks, and makes us stop what we’re doing so we can protect ourselves from harm. Our hand gets too near a flame, it hurts, we pull back.

This important function should not be under-emphasized. I had a colleague who had no feeling from the waist down due to a viral injury. Her inability to feel put her in constant danger because she had no protective pain function. She once broke an ankle because she didn’t realize her foot was stuck in a door. Pain hurts and most of the time (when it’s healthy pain), that keeps our bodies intact.

Pain also protects us is by forcing us to rest because we are tired. It takes energy to heal. Pain is exhausting. Tissue injury requires many resources to heal. Exhaustion slows us down so our body can use its resources well.

Pain can occur in the absence of damage.

The second major change is more subtle. Pain is defined as something that may resemble pain caused by actual or potential tissue damage.

Chronic pain – pain that lasts longer than six months – is often caused by the nervous system responding AS IF there were tissue damage when no damage exists. Migraine disease, trigeminal neuralgia, regional amplified pain syndrome, fibromyalgia, and other chronic pain conditions are all caused by the nervous system sending faulty ‘warning’ signals when no emergency exists and the brain responding to those signals as if the body were in danger.

So you get the aversive stimuli. You get the exhaustion and desire to rest. But it doesn’t help the body heal.

The pain itself is the disease.

In our next post, I’ll be talking about chronic pain and how body, brain, culture, and behavior combine to change the perception of pain.

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